DHIVYA BHARATHI SAMINATHAN

GROUP- 7
INTRODUCTION

Synonyms of Tietze Syndrome

Chondropathia Tuberosa
Costochondral Junction Syndrome

Tietze syndrome is a rare, inflammatory disorder characterized by chest pain

and swelling of the cartilage of one or more of the upper ribs (costochondral
junction), specifically where the ribs attach to the breastbone (sternum).

Onset of pain may be gradual or sudden and may spread to affect the arms
and/or shoulders. Tietze syndrome is considered a benign syndrome and, in
some cases, may resolve itself without treatment.

The exact cause is not known

Affected Populations
Tietze syndrome usually affects older children and young adults.
Most cases occur before the age of 40, most often during the second
or third decade of life. Although rare, Tietze syndrome has been
reported in infants, children or the elderly. Males and females are
affected in equal numbers
Signs & Symptoms
Tietze syndrome is characterized by mild to severe localized pain and
tenderness in one or more of the upper four ribs.

The second or third ribs are most often affected. In most people, the cartilage of
only one rib is affected. A firm, spindle-shaped swelling occurs in the cartilage of
the affected rib.

An aching, gripping, sharp, dull, or neuralgic pain occurs in this area. Sometimes,
the pain may spread to affect the neck, arms and shoulders. Redness (erythema)
and warmth of the affected area may be present.

The onset of pain may be gradual or sudden, and can vary in intensity. The pain
associated with Tietze syndrome may worsen due to sneezing, coughing, or
strenuous activity or exercise. The pain usually subsides after several weeks or
months, but the swelling may persist.
You might mistake the pain from Tietze syndrome for a heart attack
but there are differences:

Tietze syndrome usually only affects a small area of the chest while a
heart attack covers the whole chest. If you're having a heart attack,
you may also be short of breath, nauseous, and sweating.
Causes
The exact cause is not known (idiopathic). Some researchers have
speculated that multiple microtrauma to the anterior chest wall
may cause the development of Tietze syndrome.

Sometimes, the development of the disorder may be preceded by

chronic, excessive coughing, vomiting, trauma or impact to the
chest, viral or bacterial infections, or surgery to the thoracic area.
Related Disorders
Symptoms of the following conditions can resemble those of
Tietze syndrome. Comparisons may be useful for a differential
diagnosis:

Chest wall pain is a general term given to several conditions

characterized by anterior chest pain. A dull, aching pain occurs
which varies in response to strain, inflammation, malposition or
infiltration of muscles, ligaments, cartilage, or bones in the chest
wall.

Irritation of a nerve root from the neck or upper spine, or a

fractured rib, can also cause chest wall pain. Treatment is aimed at
the underlying cause of the pain. Tietze syndrome is part of this
group of painful conditions.
Costal chondritis or costochondritis is a common condition
characterized by inflammation of the cartilage part of the rib. It may
affect one or more rib (costal) cartilages.

It is characterized by pain of the chest wall that may spread

(radiate) to surrounding areas.

Sometimes, the terms costochondritis and Tietze syndrome are used

interchangeably. However, the two disorders are differentiated by
the presence of swelling, in addition to pain, in Tietze syndrome. In
costochondritis, there is no swelling.

Costochondritis is more common, although not exclusively, in adults

over 40 years of age.
Spinal root lesions or compression can cause chest pain in the form
of a deep, boring, aching discomfort, or a sharp sudden and piercing
pain. This pain usually occurs after sudden movement of the body,
such as sneezing, coughing, laughing or straining.

Additional disorders that can cause symptoms similar to those seen

in Tietze syndrome include seronegative arthritis, ankylosing
spondylitis, fibromyalgia, pneumonia, and coronary heart disease.

In some instances, certain forms of malignant lymphoma can cause

chest pain and swelling similar to that in Tietze syndrome.
Diagnosis

A diagnosis of Tietze syndrome is made based upon a thorough

clinical evaluation, a detailed patient history, identification of
characteristic symptoms, and exclusion of other causes of chest
pain.

A variety of tests including electrocardiogram, x-rays, and biopsies

may be performed to rule out more serious causes of chest pain
including cardiovascular disorders or malignant conditions.
Magnetic resonance imaging (MRI) can show thickening and
enlargement of affected cartilage.
Standard Therapies
Treatment
In some cases, pain associated with Tietze syndrome resolves itself without treatment.

Specific treatment for individuals with Tietze syndrome consists of rest, avoidance of
strenuous activity, the application of heat to the affected area, and pain medications such
as nonsteroidal anti-inflammatory drugs (NSAIDs) or a mild pain reliever (analgesic).

Local corticosteroid or lidocaine injections directly into the affected area may be
beneficial for people who dont respond to pain relievers (refractory cases). Usually the
pain subsides after several weeks or months, but the palpable swellings may persist for
some time.
Resources
The Genetic and Rare Diseases (GARD) Information Center, part of
the National Institutes of Health
The National Institute of Arthritis and Musculoskeletal and Skin
Diseases
The National Organization for Rare Disorders
The Arthritis Foundation
The American Academy of Pediatrics